Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
General Information
This report form generated from the Mobility Tool+ consists of the following main sections:
-
-
Context: this section resumes some general information about your project;
Implementation of the project: this section asks for information about all the stages of the
project: implementation of main activities including practical arrangements, participants'
profile, impact, dissemination of the results and future plans;
Budget: this section gives a detailed overview of the final amount of the EU grant you
request;
Check List/Data Protection Notice/Declaration of Honour: in these sections, you are made
aware of important conditions linked to the submission of this final report;
Annexes: in this section, you need to attach additional documents that are mandatory for
the completion of the report;
Submission: here, you will be able to confirm the information provided and to submit the
form online.
For your convenience, some parts of this report are prefilled with information from the Mobility
Tool+
Context
Programme
Erasmus+
Key Action
Cooperation for Innovation and the Exchange of
Good Practices
Action
Strategic Partnerships
Action Type
Strategic Partnerships for School Education
Strategic Partnerships for Vocational
Education and training
Strategic Partnerships for Higher Education
Strategic Partnerships for Adult Education
Strategic Partnerships for Youth
Strategic Partnerships for Schools Only
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Page 1 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
(Coordinator and Partners)
Main objective of the project
[OBJECTIVES]
Partnership between regions
[BOOLEAN]
Call
2016
Round
Report Type
Interim / Progress
Language used to fill in the form
[LANGUAGES]
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Page 2 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Project Identification
Grant Agreement Number
Project Title
Project Acronym
Project Start Date (dd-mm-yyyy)
Project End Date (dd-mm-yyyy)
Project Total Duration (months)
Beneficiary Organisation Full Legal Name
(Latin characters)
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Summary of Participating Organisations
Role of the
Organisation
PIC of the
organisation
Name of the
Organisation
Country of the
Organisation
Type of
Organisation
Total number of participating organisations
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Page 4 of 19
Accreditation of
organisation (if
applicable)
Activation
Start Date
Activation
End Date
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Project Management & Implementation
Please provide an overall state of play of your project: what are the achievements of the project at
this stage? Are the initial project activities and objectives being carried out and reached so far?
Please describe further in details the project activities supported by the grant for Project
Management and Implementation that have been carried out until now.
How is the monitoring of the project being carried out so far and by whom?
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
How did the project partners contribute to the project so far? Has the distribution of tasks been
adjusted since the application stage?
If your project involves other organisations, not formally participating in the project, please briefly
describe their involvement.
If relevant, please describe any difficulties you have encountered in managing the implementation of
the project and how you and your partners handle them.
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Page 6 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
[SECTION VISIBLE IF THE PROJECT CONTAINS AT LEAST ONE TRANSNATIONAL PROJECT MEETING]
Transnational Project Meetings
Please briefly describe the Transnational Project Meetings that have been organised within your
project so far.
Meeting Meeting Start End
Receiving
Receiving Receiving
ID
Title
Date Date Organisation Country
City
No. of Participants
[SUM]
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
[SECTION VISIBLE IF THE PROJECT CONTAINS AT LEAST ONE INTELLECTUAL OUTPUT]
Intellectual Outputs
Please note that the below data is a representation from the relevant section in MT+
Output Identification
O1
Output Title
Output Description
Start Date (dd-mm-yyyy)
End Date (dd-mm-yyyy)
Available Languages
[LANGUAGES]
Available Medias
[MEDIAS]
Leading Organisation
Participating Organisations
[+][-]
Output Identification
O2
Output Title
Output Description
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Page 8 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Start Date (dd-mm-yyyy)
End Date (dd-mm-yyyy)
Available Languages
[LANGUAGES]
Available Medias
[MEDIAS]
Leading Organisation
Participating Organisations
[+][-]
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Page 9 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
SECTION VISIBLE IF THE PROJECT CONTAINS AT LEAST ONE MULTIPLIER EVENT]
Multiplier Events
Please note that the below data is a representation from the relevant section in MT+
Event Identification
E1
Event Title
Event Description
Country of Venue
[COUNTRIES]
Start Date (dd-mm-yyyy)
End Date (dd-mm-yyyy)
Intellectual Outputs Covered (using Output
Identification number)
Leading Organisation
Participating Organisations
[+][-]
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
[SECTION VISIBLE IF THE PROJECT CONTAINS AT LEAST ONE LTT ACTIVITY]
Learning/Teaching/Training Activities
Please note that the below data is a representation from the relevant section in MT+
Activity No.
C1
Field
[FIELDS]
Activity Type
[PROGRAMME_TREE]
Activity Description
No. of Participants
Participants with Special Needs (out of total number of
Participants)
Accompanying Persons (out of total number of
Participants)
Is this a long-term activity?
[BOOLEAN]
Funded Duration (days)
Participating Organisations
[+][-]
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Page 11 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Follow-up
Impact
What has been the project's impact so far on the participants, participating organisations, target
groups and other relevant stakeholders?
Dissemination and Use of Projects' Results
In case already applicable, to whom did you disseminate the project results inside and outside your
partnership so far? Please define in particular your targeted audience(s) at
local/regional/national/EU level/international and explain your choices.
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Page 12 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Budget
Budget Summary
Learning/Teaching/Training Activities
PIC of the
Organisation
Project Management
and Implementation
Transnational
Project Meetings
Intellectual
Outputs
Multiplier
Events
Total
[SUM]
[SUM]
[SUM]
[SUM]
EU
Travel
Grant
[SUM]
EU Individual
Support
Linguistic
Support
Grant
Exceptional
Costs
(Overseas
Countries
and
Territories
Travel
Costs)
[SUM]
[SUM]
[SUM]
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Special
Needs
Support
Exceptional
Costs
Exceptional
Costs Guarantee
Total
(Calculated)
[SUM]
[SUM]
[SUM]
[SUM]
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Further Pre-financing request
Are you requesting a further pre-financing payment?
[BOOLEAN]
YES
NO
Total amount
Grant awarded as stated in your Grant Agreement
Amount of Pre-financing payments already received
Amount of pre-financing payments used
Amount of further Pre-financing payment requested by the beneficiary to the National Agency
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Page 14 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Checklist
Before submitting your report form to the National Agency, please check that:
 all necessary information on your project have been encoded in Mobility Tool+
 the report form has been completed using one of the languages specified in the Grant
Agreement.
 you have annexed the Declaration of Honour signed by the legal representative of the
beneficiary organisation.
 you have saved or printed the copy of the completed form for yourself.
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Page 15 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Data Protection Notice
PROTECTION OF PERSONAL DATA
The form will be processed electronically. All personal data (such as names, addresses, CVs, etc.) will
be processed in pursuant to Regulation (EC) No 45/2001 on the protection of individuals with regard
to the processing of personal data by the Community institutions and bodies and on the free
movement of such data. Any personal data requested will only be used for the intended purpose,
i.e.:
- In the case of report forms: statistical and financial (if applicable) follow-up of the projects.
For the exact description of the collected personal data, the purpose of the collection and the
description of the processing, please refer to the Specific Privacy Statement accompanying this form.
You are entitled to obtain access to your personal data on request and to rectify any such data that is
inaccurate or incomplete. If you have any queries concerning the processing of your personal data,
you may address them to your National Agency. You have the right of recourse at any time to your
national supervising body for data protection or the European Data Protection Supervisor for matters
relating to the processing of your personal data.
You are informed that for the purposes of safeguarding the financial interest of the Communities,
your personal data may be transferred to internal audit services, to the European Court of Auditors,
to the Financial Irregularities Panel and/or to the European Anti-Fraud Office (OLAF).
Any personal data shall be processed by the National Agencies pursuant to Regulation No 45/2001 of
the European Parliament and of the Council on the protection of individuals with regard to the
processing of personal data by the institutions and bodies of the Community and on the free
movement of such data.
http://www.edps.europa.eu/
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Beneficiary Declaration of Honour and Signature
I, the undersigned, certify that the information contained in this report form and its annexes is
accurate and in accordance with the facts. In particular the financial data provided corresponds with
the activities actually realised and to the funds actually paid.
Place:
Date (dd-mm-yyyy):
Name of the beneficiary organisation:
Name of legal representative:
Signature:
National ID number of the signing person (if requested by the National Agency):
Stamp of the beneficiary organisation (if applicable):
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Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Submission
Before submitting the form electronically, please validate it. Please note that only the final version of
your form should be submitted electronically.
Data Validation
Validation of compulsory fields and rules
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Standard Submission Procedure
Online submission (requires internet connection)
Submit Online
Alternative Submission Procedure
If you cannot submit your form online you can still do it by sending an email to your National Agency.
The email must contain the complete electronic form and any file attachments you wish to send. You
must also attach a snapshot of section "Submission Summary" indicating that this electronic form
could not be submitted online. Your National Agency will analyse your situation and provide you with
further instructions.
Submission Summary
This table provides additional information (log) of all form online submission attempts.
Number
1
Time
2014-03-21 17:51:23
(Brussels, Belgium Time)
Form Hash Code
0000000000000000
Submitted
Description
Yes
Your
submission
was successful.
Submission ID:
1000785
Local Time cannot be considered authoritative and cannot be used for claiming that the form has
been submitted in time.
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Page 18 of 19
Interim Report Form
Call: 2016
KA2 – Cooperation for Innovation and the
Exchange of Good Practices
Erasmus+
Form Printing
Print the entire form
Print Form
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Page 19 of 19